OPHTE# mil- s a~'/Zv Harnett County Department of Public Health
PERMIT # a t-~- y 7 Operation Per it 2 21 7 8
New Installationc Tank Nitrification Line ❑ Repair ❑ Expansion
/ PROPERTY LOCATION: l 1 L. led.
Name: (owner) A1,4. c Co w 1'~✓ ~ c't SUBDIVISION «-f a ~ LOT # 5s
System Installer: IMA 14 - Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 2/ Public ❑ Well Distance from well feet
System Type: 1TL G- Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
ims system nas been instaneo in compliance wan applicable north Carolina beneral Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization.
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PERMIT CONDITIONS:
1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
❑ D-Box ❑ Pump ❑ Alarm ❑ H20Line ❑ PWR Line
Following are the specifications for the sew disposal s stem on the above captioned property.
Type of system: ❑ Conventional Other Qu: ,k y Ck --5e-- Septic Tank: gallons Pump Tank: gallons
Subsurface No. of exact length 13 width of depth of
Drainage Field ditches of each ditch feet ditches 3 feet ditches- inches
French Drain Required: Linear feet
Authorized State Agent ~'`Y Date
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